Topics in hospital pharmacy management最新文献

Appropriate drug therapy is centered on the acts of selection and dosing of pharmaceuticals. Prescribing drugs has been the exclusive province of physicians until recently. Pharmacists and others who seek to encourage physicians to prescribe specific drugs or therapies or to use pharmaceuticals in a particular manner have addressed their concerns through influence. The article examines direct and indirect methods of influencing prescribers. The changing goals of providers, payers, pharmacists, and patients are discussed, and the effectiveness of various methods of influencing prescribers are reviewed, including financial incentives, drug use evaluation, persuasion, collaboration, and computer-aided information delivery.

A literature review of articles describing the development and implementation of automated medication administration records is summarized, and the results of a survey undertaken of all hospitals in Missouri to determine the extent of an automated medication administration record (MAR) are reported. For hospitals with an automated MAR, the survey compiled information about the demographics of responding facilities and production and distribution, design, implementation, and procedures for use of automated MARs. The most frequently reported advantages of an automated MAR were a more legible document, increased accuracy, savings in nursing personnel time, and fewer medication errors. The most frequently reported disadvantages were increases in pharmacy personnel time, different interpretation of orders by pharmacy and nursing, and multiple entries required for a medication order to appear correctly on the MAR.

A commitment was made at a 1,025-bed county teaching facility to increase staff pharmacists' involvement in nutritional support and physician prescribing. The plan was to utilize the Nutritional Support Clinical Pharmacy Specialist (NSCPS) to train the staff pharmacists to provide direct patient care for patients receiving parenteral nutrition. The implementation included specialized training for staff pharmacists, staff pharmacists monitoring all parenteral nutrition patients, pharmacists' attendance at nutritional support rounds, documentation of all pharmacist interventions, and pharmacists' involvement in the drug-usage evaluation (DUE) process. The results of the increased influence of pharmacists on the prescribing process included more appropriate parenteral nutrition therapy, earlier transitioning from parenteral to enteral nutrition, recognition of staff pharmacists as resources by the physicians, and increased job satisfaction for pharmacists.

Influencing prescribing practices and the implementation of pharmaceutical care utilizing the drug use evaluation (DUE) process at a 891-bed teaching hospital are described. The DUE program has been structured to provide for significant pharmacy involvement while maintaining medical staff responsibility as outlined by the Joint Commission on Accreditation of Healthcare Organizations. A multidisciplinary approach is used to identify problems and develop prescribing criteria and educational initiatives. Pharmacists provide drug therapy monitoring and engage in clinical interventions and documentation of outcomes on a daily basis. DUE program pharmacists help target possible interventions, assure monitoring and outcome documentation, and compile results of all initiatives for reporting purposes to the medical staff and quality assessment program. Specific performance compliance and problems are identified and incorporated into the credentialing process. Corrective measures are determined by the Pharmacy and Therapeutics (P&T) Subcommittee with subsequent actions carried out by peer physicians. The net result is a positive influence on prescribing practices that improves the appropriate and effective use of drugs and improves patient outcomes.

On-line prescribing is available in many hospitals in the United States and has distinct advantages. On-line drug prescribing can be influenced by the use of automated prompts that guide and direct the prescriber to the preferred agent, dosage, or regimen. The authors have adapted screen prompts to facilitate appropriate prescribing as defined by pharmacy and therapeutic (P&T) committee decisions, restricted drug or target drug initiatives, drug-usage evaluation (DUE) actions, departmental guidelines and order-sets, and other institutional directives. Objective evidence for the effectiveness of on-line prompts is provided for H2-antagonists and antibiotics. As computer technology advances even further and is increasingly utilized in the health care setting, on-line interventions to facilitate appropriate prescribing may become increasingly useful.

Oncology research protocol management is important for the effective execution of clinical trials with oncology patients. Clinical trials explore investigational drug safety, efficacy, and effectiveness. Investigational drugs have not received approval for widespread use and marketing by the Food and Drug Administration (FDA). The National Cancer Institute (NCI) has several branches concerned with investigational drug procurement, distribution, and recordkeeping of investigational cancer chemotherapy agents. Before an investigational drug is approved by the FDA for marketing in the United States, it must undergo several phases of pre-clinical and clinical trials. The Institutional Review Board (IRB) must review and approve clinical trials to ensure that studies meet legal, ethical, and scientific standards. The principal investigator (PI) takes responsibility for the clinical trial. Informed consent must be obtained from subjects before they may participate in clinical trials. The informed consent form is reviewed by the IRB. The investigational drug storage, accountability, ordering, distribution, and drug information dissemination process is improved with a pharmacy-coordinated investigational drug service.

Early recognition and prompt control are the two major factors in dealing with oncologic emergencies. The most common emergencies are tumor lysis syndrome, hypercalcemia, spinal cord compression, and superior vena cava syndrome. Emergencies in cancer can occur at any stage of the disease process or its treatment. It is very important that caregivers are able to recognize and manage these emergencies; serious complications can arise if they are not treated promptly.

Understanding the toxicities associated with cancer chemotherapeutic agents is essential to pharmacists involved in the clinical management of oncology patients. Anticipation of various treatment-related toxicities may provide the opportunity for pharmacists to develop intervention strategies that could minimize or eliminate an expected side effect of chemotherapy such as myelosuppression, nausea, or emesis. Effective management of chemotherapy toxicities may lead to decreased lengths of stay in the hospital or administration of chemotherapy in the outpatient setting. This article addresses the onset of chemotherapy toxicities, the major organ system toxicities, and the management of many of these chemotherapy-induced toxicities. Chemotherapy dose modifications are discussed as well as maximum lifetime doses and the use of prophylactic medications to prevent various side effects.

Managers should be aware of the hazardous properties of antineoplastic drugs and of the procedures and equipment commonly recommended to provide a safe working environment for employees, patients, and visitors. Compliance with the many published guidelines should help ensure passage of the inevitable Occupational Safety and Health Administration (OSHA) or Joint Commission inspection. Acute and chronic toxicities of the antineoplastic drugs, the potential for exposure in the workplace, and the basic guidelines for safe handling of these agents are reviewed.

The administration of cancer chemotherapy is a unique combination of scientific exercise and clinical practice. The clinical practice involves the holistic care of a human being whose cancer and normal physiology are unique. The scientific exercise includes the manipulation of doses, combinations, and administration schemes of the small number of chemicals known as chemotherapy. Bringing science and clinical practice together to formulate a treatment plan that offers the most favorable outcomes and that minimizes short- and long-term toxicities is a challenge. This article discusses the scientific rationale for various methods of chemotherapy administration and outlines the specific clinical steps necessary to achieve the most safe and efficacious administration plan possible.